UPPER EXTREMITY THROMBOEMBOLISM CAUSED BY OCCLUSION OF AXILLOFEMORAL GRAFTS

BACKGROUND: The axillofemoral bypass graft (AxFG) is increasingly acce pted as treatment for lower extremity ischemia caused by aortoiliac oc clusive disease in high-risk patients. The incidence of upper extremit y (UE) thromboembolism caused by occlusion of an AxFG and the results of treatment form the basis for this report. METHODS: From 1984 to the present, all patients undergoing axillofemoral bypass grafting were f ollowed up in a vascular registry. A standardized operative technique, using an externally supported 8-mm polytetrafluoroethylene graft, was used in performing 202 AxFGs in 182 patients. UE thromboembolism caus ed by occlusion of an AxFG was identified by retrospective patient rec ord review. RESULTS: Occlusion of an AxFG occurred in 20 patients. Fif teen patients (75%) underwent immediate revision of the occluded graft . Two patients (10%) developed UE thromboembolism simultaneous with gr aft occlusion. One of these patients had immediate revision of the gra ft, and 1 had brachial embolectomy only. This patient and 4 others (25 %) had the occluded AxFG left in place. Four of these 5 patients (80%) developed UE thromboembolism at 26 days, 2 years, 5 years, and 7 year s, respectively, after occlusion. Overall, six UE thromboembolic compl ications occurred in 5 patients. CONCLUSIONS: UE thromboembolism repre sents a significant and specific complication of occluded AxFGs in our series (2.7% of patients, 25% of occluded grafts). It may be prudent to prophylactically detach the axillary portion of the graft and repai r the axillary artery in patients who do not require immediate revisio n of an occluded AxFG.